Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | MD00022676 | WA |
Y | 207VG0400X | Gynecologist | MD00022676 | WA |
NPI | 1134147739 |
---|---|
Provider Name | Peter E Fern |
First Address | Spokane, WA 99204 |
Second Address | Spokane, WA 99204-2319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 19/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003160 | (05) | WA |
1003896 | (05) | WA |
A07179 | (02) | WA |